According to study 14 of sexually active high school and college women are asymptomatic carriers

Non-sexual transmission also occurs

Major source is non-chlorinated swimming pools

Newborns contract conjunctivitis much like with gonorrhea

24Chlamydial Genital System Infections

Prevention and Treatment

Abstinence

Monogamous relationship

Use of condom

All sexually active women should get tested annually

Semi annually if multiple partners

Azithromycin effective single dose treatment

Tetracycline and erythromycin less expensive alternatives

25Genital Herpes

Symptoms

Begin 2 to 20 days post infection

Genital itching and burning

Pain

Primarily in women

Blisters develop on genitals

Blisters heal spontaneously

Most patients will have recurrence

Causative Agent

Usually herpes-simplex virus type 2

DNA virus

Disease recurrence due to latent virus

26Genital Herpes

Pathogenesis

Blisters created by infected epithelial cells

Blisters contain large numbers of bacteria

Blisters rupture to produce painful ulcerations

Latency follows ulceration

Viral DNA exists in cell in non-infectious form within nerve cell

Recurrence is due to replication of complete virions from latent DNA

Viruses re-infect area supplied by nerve

Congenital herpes can pose serious risk for newborn

1 in 3 newborns contract herpes if mother has primary infection at time of birth

Can be debilitating and potentially lethal

27Genital Herpes

Epidemiology

No animal reservoir

Virus can survive short time on fomites or in bathwater

Non-sexual transmission rarely occurs

Sexual transmission most likely occurs during first days of symptomatic disease

Transmission can occur in absence of symptoms

Once infected there is lifelong risk of transmission

28Genital Herpes

Prevention and Treatment

Avoidance of sexual intercourse during active symptoms

Use of condom and spermicide reduce but do not eliminate transmission

There is no cure for genital herpes

Medications such as acyclovir and famciclovir can decrease severity

29PapillomavirusGenital Warts and Cervical Cancer

Symptoms

Individual may be asymptomatic

Especially women

Genital warts most easily recognized symptom

Often appear on the head or shaft of penis, at the vaginal opening or around anus

Warts can become inflamed or bleed

Precancerous lesion on cervix often asymptomatic

Can be detected with vaginal exam (pap smear)

30PapillomavirusGenital Warts and Cervical Cancer

Causative agent

Human papillomavirus (HPV)

Non-enveloped, double stranded DNA virus

Nearly 100 types of HPV

30 are transmitted sexually

15 type strongly associated with cancer

Four account for most cases in U.S. (Types 6, 11, 16, and 18)

The Gardasil vaccine protects against these

PathogenesisHPV enters and infects deeper layers of tissue through abrasionsMay lead to latent infectionMechanism of wart formation is unknownWarts usually appear about 3 months after infectionRemoval of warts does not eliminate virusHPV can be transmitted to fetus through birth canalMost cervical cancers associated with HPV

31PapillomavirusGenital Warts and Cervical Cancer

Epidemiology

HPV readily spread through sexual contact

Asymptomatic carriers can infect others with HPV

HPV most common reason for abnormal pap smear

History of multiple sex partners is most important risk factor for acquiring HPV

Warts can develop in the mouth via oral sex

32PapillomavirusGenital Warts and Cervical Cancer

Prevention and Treatment

Condom use can help decrease chance of transmission

Women should have pap smear annually

Can identify precancerous lesions

Abnormal growth can be removed preventing development of cancer

Warts can be removed by laser treatment or freezing with liquid nitrogen

33Nervous System Infections

Chapter 27

34Meningococcal Meningitis

Symptoms

First symptoms similar regardless of agent

Mild cold followed by onset of throbbing headache

Fever

Pain and stiffness of neck and back

Nausea and vomiting

Deafness and alteration in consciousness may appear progressing to coma

Small hemorrhages called petechiae may appear on skinInfected person may develop shock and die within 24 hoursUsually progression of disease is slower allowing time for treatment

35Meningococcal Meningitis

Inflammation causes swelling of brain tissueCan also cause obstruction of outflow of CSFCauses brain to squeeze against skullRelease of endotoxin causes drop in blood pressure leading to shock

Pathogenesis

Acquired by inhaling infected respiratory droplets

Bacteria adhere to mucous membranes via pili and multiply

Invade bloodstream by passing through respiratory epithelium

Bloodstream carries organisms to CSF

Organisms phagocytized by neutrophils

Enter fluid in large numbers

36Meningococcal Meningitis

Causative agent

Neisseria meningitidis

Gram negative diplococci

12 antigenic serotypes

Most serious infections due to types A,B,C and Y

EpidemiologyN. meningitis more prone to cause epidemicsReasons unknownCan spread rapidly in crowded stressed placesHuman only source of infectionTransmission can occur with disease or asymptomatic carrierOrganism recovered from 5 - 15 of healthy individuals

37Meningococcal Meningitis

Prevention and Treatment

Vaccine is available

Used to control epidemics

Not given routinely due to ineffectiveness in children less than 2 years of age

Effect is not long lasting

Mass prophylaxis with antibiotics helpful at controlling epidemics in small populations

Individuals immediately exposed given antibiotic rifampin

Can usually be cured unless brain injury or shock present

Mortality is less than 10 in treated populations

38Viral (Aseptic) Meningitis

Symptoms

Typically abrupt in onset

Characterized by

Fever

Severe headache above or behind eyes

Sensitivity to light

Nausea and vomiting

May have sore throat, chest pain, swollen parotid gland and skin rash

Depends on causative agent

39Viral Meningitis

PathogenesisBegins with infection of throat and intestinal epitheliumProgresses to lymphoid tissue in the bloodstreamViremia results in meningeal infectionMay also be responsible for rash and chest pain

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